Enterotoxigenic Escherichia coli (ETEC) are a principal cause of diarrhea in young children in resource-limited countries and also travelers to these areas (1, 2). ETEC produce disease by adherence to small intestinal epithelial cells and expression of a heat-labile (LT) and/or heat-stable (ST) enterotoxin (3). ETEC typically attach to host cells via filamentous bacterial surface structures known as colonization factors (CFs). More than 20 different CFs have been described, a minority of which have been unequivocally incriminated in pathogenesis (4).
Firm evidence for a pathogenic role exists for colonization factor antigen I (CFA/I), the first human-specific ETEC CF to be described. CFA/I is the archetype of a family of eight ETEC fimbriae that share genetic and biochemical features (5, 4, 6, 7). This family includes coli surface antigen 1 (CS1), CS2, CS4, CS14, CS17, CS19 and putative colonization factor O71 (PCFO71). The complete DNA sequences of the gene clusters encoding CFA/I, CS1 and CS2 have been published (8, 9, 10, 11, 12). The genes for the major subunit of two of the other related fimbriae have been reported (13, 6). The four-gene bioassembly operons of CFA/I, CS1, and CS2 are similarly organized, encoding (in order) a periplasmic chaperone, major fimbrial subunit, outer membrane usher protein, and minor fimbrial subunit. CFA/I assembly takes place through the alternate chaperone pathway, distinct from the classic chaperone-usher pathway of type I fimbrial formation and that of other filamentous structures such as type IV pili (14, 15). Based on the primary sequence of the major fimbrial subunit, CFA/I and related fimbriae have been grouped as class 5 fimbriae (16).
Studies of CS1 have yielded details on the composition and functional features of Class 5 fimbriae (17). The CS1 fimbrial stalk consists of repeating CooA major subunits. The CooD minor subunit is allegedly localized to the fimbrial tip, comprises an extremely small proportion of the fimbrial mass, and is required for initiation of fimbrial formation (18). Contrary to earlier evidence suggesting that the major subunit mediates binding (19), recent findings have implicated the minor subunit as the adhesin and identified specific amino acid residues required for in vitro adhesion of CS1 and CFA/I fimbriae (20). The inferred primary amino acid structure of those major subunits that have been sequenced share extensive similarity. Serologic cross-reactivity of native fimbriae is, however, limited, and the pattern of cross-reactivity correlates with phylogenetically defined subtaxons of the major subunits (13).
Implication of the minor subunits of Class 5 fimbriae as the actual adhesins entreats scrutiny regarding the degree of their conservation relative to that of the major subunits. It was speculated that CooD and its homologs retained greater similarity due to functional constraints imposed by ligand binding requirements and/or its immunorecessiveness, itself attributable to the extremely large ratio of major to minor subunits in terms of fimbrial composition. Studies were conducted to examine the evolutionary relationships of the minor and major subunits of Class 5 ETEC fimbriae as well as the two assembly proteins (21). It was demonstrated that evolutionary distinctions exist between the Class 5 major and minor fimbrial subunits and that the minor subunits function as adhesins. These findings provide practical implications for vaccine-related research.
The nucleotide sequence of the gene clusters that encode CS4, CS14, CS17, CS19 and PCFO71 was determined from wild type diarrhea-associated isolates of ETEC that tested positive for each respective fimbria by monoclonal antibody-based detection (21). The major subunit alleles of the newly sequenced CS4, CS14, CS17 and CS19 gene clusters each showed 99-100% nucleotide sequence identity with corresponding gene sequence(s) previously deposited in GenBank, with no more than four nucleotide differences per allele. Each locus had four open reading frames that encoded proteins with homology to the CFA/I class chaperones, major subunits, ushers and minor subunits. As previously reported (13), the one exception was for the CS14 gene cluster, which contained two tandem open reading frames downstream of the chaperone gene. Their predicted protein sequences share 94% amino acid identity with one another and are both homologous to other Class 5 fimbriae major subunits.
Examination of the inferred amino acid sequences of all the protein homologs involved in Class 5 fimbrial biogenesis reveals many basic similarities. Across genera, each set of homologs generally share similar physicochemical properties in terms of polypeptide length, mass, and theoretical isoelectric point. All of the involved proteins contain an amino-terminal signal peptide that facilitates translocation to the periplasm via the type II secretion pathway. None of the major subunit proteins contain any cysteine residues, while the number and location of six cysteine residues are conserved for all of the minor subunits except that of the Y. pestis homolog 3802, which contains only four of these six residues.
Type 1 and P fimbriae have been useful models in elucidating the genetic and structural details of fimbriae assembled by the classical chaperone-usher pathway (23, 24, 25). An outcome of this work has been development of the principle of donor strand complementation, a process in which fimbrial subunits non-covalently interlock with adjoining subunits by iterative intersubunit sharing of a critical, missing β-strand (22, 26). Evidence has implicated this same mechanism in the folding and quaternary conformational integrity of Haemophilus influenzae hemagglutinating pili (28), and Yersinia pestis capsular protein, a non-fimbrial protein polymer (29). Both of these structures are distant Class I relatives of Type 1 and P fimbriae that are assembled by the classical chaperone-usher pathway. From an evolutionary perspective, this suggests that the mechanism of donor strand complementation arose in a primordial fimbrial system from which existing fimbriae of this Class have derived. While donor strand complementation represents a clever biologic solution to the problem of protein folding for noncovalently linked, polymeric surface proteins, its exploitation by adhesive fimbriae other than those of the classical usher-chaperone pathway has not been demonstrated.
Common to fimbriae assembled by the alternate chaperone pathway and the classical chaperone-usher pathway are the requirement for a periplasmic chaperone to preclude subunit misfolding and an usher protein that choreographs polymerization at the outer membrane. That the fimbrial assembly and structural components of these distinct pathways share no sequence similarity indicates that they have arisen through convergent evolutionary paths. Nevertheless, computational analyses of the CFA/I structural subunits suggests the possibility that donor strand complementation may also govern chaperone-subunit and subunit-subunit interaction.
The eight ETEC Class 5 fimbriae clustered into three subclasses of three (CFA/I, CS4, and CS14), four (CS1, PCFO71, CS17 and CS19), and one (CS2) member(s) (referred to as subclasses 5a, 5b, and 5c, respectively) (21). Previous reports demonstrated that ETEC bearing CFA/I, CS2, CS4, CS14 and CS19 manifest adherence to cultured Caco-2 cells (6, 22). However, conflicting data have been published regarding which of the component subunits of CFA/I and CS1 mediate adherence (19, 20).
This question of which fimbrial components is responsible for mediating adherence was approached by assessing the adherence-inhibition activity of antibodies to intact CFA/I fimbriae, CfaB (major subunit), and to non-overlapping amino-terminal (residues 23-211) and carboxy-terminal (residues 212-360) halves of CfaE (minor subunit) in two different in vitro adherence models (21). It was demonstrated that the most important domain for CFA/I adherence resides in the amino-terminal half of the adhesin CfaE (21).
The studies briefly described above provide evidence that the minor subunits of CFA/I and other Class 5 fimbriae are the receptor binding moiety (20, 21). Consistent with these observations, because of the low levels of sequence divergence of the minor subunits observed within fimbrial subclasses 5a and 5b (20), the evolutionary relationships correlated with cross-reactivity of antibodies against the amino-terminal half of minor subunits representing each of these two subclasses (21). These studies strongly suggest that the minor subunits of class 5 fimbriae are much more effective in inducing antiadhesive immunity and thus an important immunogen for inducing protective antibody (21).
Anti-diarrheal vaccines would be a preferable method of conferring protection against diarrheal disease including ETEC caused diarrhea. However, because of the complexities of constructing and licensing of effective vaccines other methods to confer interim protection have been sought. A measure shown to hold considerable promise in the prevention of diarrhea is passive, oral administration of immunoglobulins against diarrhea causing enteropathogens. Products with activity against ETEC, Shigella, and rotavirus have been shown to prevent diarrhea in controlled studies with anti-cryptosporidial bovine milk immunoglobulins (BIgG) preparations (30-33). Furthermore, favorable encouraging results have been observed using this approach with anti-cryptosporidial BIgG preparations (34, 35).
Accordingly, an object of this invention is an immunoglobulin supplement capable of providing prophylactic protection against ETEC infection. Because the minor subunit (adhesin) is the fimbrial component directly responsible for adherence, administration of anti-adhesin antibodies will likely confer significantly greater protection than antibodies raised against intact fimbriae or intact bacteria. Furthermore, another object of the invention is a method for the production of passive prophylactic formulation against ETEC, containing anti-adhesin immunoglobulin. The use of recombinant minor fimbrial subunit polypeptides in the immunoglobulin production method will provide enhanced antibody yields and standardization over the use of intact fimbriae or whole cells.